3966 Palisade Way - Tie In Card EAGpN >TpWNSHIY
3795 Pilot nn ob tao ad
St. Paul,
Telephone 4544242
PERMIT FOR WATER SERVICE CONNECTION
A Number:
Date: '��� i� '1 � � l L l 4
f l ��( ��P Site Address
8111ing Name:1 � 4_�
Owner: k Billing Address
Plumber :. i t.-r
hg• �,...r O /2
ter Size Connection C . 5
O/2
Location of Convection Permit Fee 10 � /2
Meter No.
Meter Readi °D&..._--. Meter Dep -----
b
,,)) / Meter Sealed: Yes_, Add'l Chg•„�.�.,
1— ND, Total Chg. -----.
c. Inspected by
D a t e . . . , . / L , - , 0 . . ; . . " 7'+-
Building is a:
Remarks:
Residence
Multiple _ No. Units
Commercial —
Induetrial..— BY' Chief Inspector
other
Inconsideration of the issue and delivery to tme of the above permit, I
hereby agree to do tbe- proposed work in accordance with the rules an
hi D County, Mian a
eao . p . -
regulations of Began Towne P� )Pl 4�i I `
By:
(f Q. ("; ; i tr 411 ps i
Pleaae ; aotify the above office when ready for inspection and connection.